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Transplantation  of  teeth  into  artificial 
sockets 


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Transplantation  of  Teeth   ,  ^  ^  C^uM^^. 

INTd 

Artificial  Sockets 


BY 

\Vm.    J.     VOUNGEK,    XI.     \J. 

KX'I'i-nilclcDC  or  (he  C'liMfomla  State  UuntM  AsHoclAtloD. 

Ex-ProsKlent  Sail  FraiK'laco  Dental  AsaocUtloii. 

SAN  PBANCISCO,  CAL. 


REPBlfT  FBOM 

"Pacific  Medical  and  SurgicalJournal  and  Western  Lancet" 

JaXUAKY,  1886. 

With  Addenda. 


Transplantation  of  Teeth 


INTO 


Artificeil  Sockets 


BY 


WM.  J.   YOUXGER,  M.  D. 

Ex-Presidint  of  the  California  State  Dental  Association. 
Ex-President  San  Francisco  Dental  Association. 


SAN  FRANCISCO,  CAL. 


Reprint  from 

"^  Pacific  Medical  and  Surgical  Journal  and  IVestern  Lancet,' 

January,  i886. 

With  Addenda. 


SA.V  FRANCISCO: 

IV'm.  S.  Duncombe  «&*  Co.,  Publishers, 

211  Post  Street. 


TRANSPLANTATION  OF  TEETH 


INTO 


Artificial   Sockets. 


Transplantation  of  teeth  from  one  mouth  to  another  is  not,  by 
any  means,  a  new  operation,  as  it  was  done  many  years  ago  for 
the  noble  and  the  ojjulent  of  the  old  world.  li.  is  not  only 
mentioned  in  some  of  the  very  old  works  on  surgery,  but  even 
by  writers  of  fiction.  Not  only  did  the  poor  mar  their  mouths 
to  sell  their  teeth,  but  even  the  freshly  dead  were  disfigured  for 
this  purpose.  Victor  Hugo,  himself,  utilizes  a  knowledge  of 
this  operation  in  "  Les  Miserables,"  and  makes  one  of  his  her- 
oines, Fanchon,  sell  two  of  her  front  teeth  in  order  to  procure 
food  for  her  starving  child.  But  so  many  disastrous  conse- 
quences occurred,  so  many  painful  effects  followed,  and  so 
many  failures  happened,  that  the  operation  fell  into  disrepute 
and  was  abandoned  as  soon  as  artificial  substitutes  were  invented 
that  approached,  in  some  measure,  a  natural  appearance  and 
in  some  degree  served  the  purpose  of  mastication. 

Not  until  I  was  in  Paris  in  1877,  however,  did  I  learn  how 
the  operation  of  transplantation  was  effected,  and  in  learning 
that,  I  acquired  an  insight  into  the  causes  of  the  many  disas- 
trous, painful  and  futile  results. 


I  will  let  Dr.  Thomas  W.  Evans,  the  famous  dentist  of  the  Em- 
pire, and  intimate  friend  of  Napoleon  III,  explain,  in  his  own 
language  —  during  a  conversation  on  professional  topics  —  as 
nearly  as  I  can  recollect  it,  the  modas  operandi  of  transplanta- 
tion, and  the  reason  of  his  abandonment  of  it,  as  it  was  the 
narration  of  this  incident  in  his  practice  that  revealed  to  me  the 
method  pursued  in  transplanting  teeth,  and  awoke  the  sugges- 
tions in  my  mind,  that  have  made  this  operation,  in  my  hands, 
the  reverse  of  what  it  has  been.  But  I  wish  it  to  be  distinctly 
understood,  that  in  whatever  strictures  I  may  make  on  the  oper- 
ation as  illustrated  in  the  ease  related  by  Dr.  Evans,  I  do  not, 
in  the  least,  intend  to  reflect  on  him,  for  I  have  the  highest 
esteem  and  respect  for  the  professional  skill  and  attainments, 
erudition  and  private  worth  that  have  gained  for  this  distinguished 
gentleman,  a  social  position  that  has  contributed  immensely  in 
elevating  the  status  of  dental  professional  life  abroad.  Dr.  Evans 
simply  followed  the  beaten  path,  and  was  therefore  not  respon- 
sible for  it.     But  to  return  to  the  subject. 

"  The  last  operation  of  this  kind  that  I  ever  attempted,"  said 
he,  "  was  that  on  a  certain  Marquise,  who  shall  be  nameless  in 
consequence  of  the  unfortunate  results  that  followed  the  oper- 
ation. She  was  a  young,  rich  and  lovely  woman,  but  whose 
beauty  was  marred  by  the  presence  of  four  dead,  black,  badly 
decayed  front  teeth,  which  were  a  constant  source  of  mortifica- 
tion to  her.  She  had  such  an  aversion  to  wearing  false  teeth 
that  she  would  not  consent  to  an  artificial  substitute;  so  the  op- 
eration of  transplantation  was  decided  on.  One  of  her  maids 
was  thereupon  commissioned  to  search  among  her  friends  and 
acquaintances  for  a  woman  whose  teeth  would  in  size,  contour  and 
color  suit  the  requirements  of  the  case.  At  last  one  was  found 
whose  teeth  seemed  in  every  way  suitable,  and  the  consideration 
for  them  agreed  upon.     As  it  was  not  desirable  that  the  parties 


should  know  or  afterwards  recognize  one  another,  the  utmost 
secresy  had  been  preserved,  and  was  carried  out  to  the  end,  in 
thiswise:  Two  chairs  were  placed  back  to  back.  The  Marquise, 
heavily  veiled,  was  seated  in  one,  and  the  woman,  also  heavily 
veiled,  was  then  brought  in  and  placed  in  the  other.  The  lady's 
teeth  were  then  drawn  and  laid  aside,  and  then  the  woman's, 
which  were  immediately  fitted  into  the  gaping  sockets  of  the 
Marquise's,  and  tied  in  by  ligatures  to  the  adjoining  teeth.  The 
woman  was  then  led  out,  paid,  and  all  further  interest  in  her,  I 
supposed,  ended.  Not  so,  however,  for,  as  it  afterwards  trans- 
pired, this  woman  had  been  leading  an  immoral  life,  had  con- 
tracted a  loathsome  disease,  which  was,  unfortunately,  commu- 
nicated to  the  Marquise,  and  produced  in  her  great  anguish  of 
mind  and  body,  and  the  subsequent  loss  of  the  teeth.  I  came 
in  for  a  share  in  the  blame,  for  not  having  sufficiently  examined 
the  woman  as  to  her  health  and  moral  status.  I  then  determined 
never  to  perform  the  operation  of  transplantation  again;  it  was 
fraught  with  too  much  danger." 

This  then  was  the  method  practiced  in  transplantation.  The 
subjects  were  brought  together,  the  fresh,  blood  covered  teeth 
of  one,  with  whatever  of  tartar  and  filth  had  accumulated  on 
them,  were  immediately  transfei-red,  into  the  raw,  bleeding  and 
clotted  sockets  of  the  other;  each  tooth  having  in  its  body  a 
mass  of  soft  tissue,  known  as  the  pulp,  whose  life  was  ex- 
tinguished as  soon  as  rupture  of  its  tissues  occurred  at  the  apex 
of  the  root;  and  which,  being  deprived  of  vitality,  was  bound  to 
decompose  with  all  the  attendant  phenomena  of  putrefaction, 
to  wit  :  formation  of  gases,  pus,  etc.  With  this  style  of 
procedure,  the  wonder  to  me  is,  that  the  operation  was  ever 
successful. 

In  the  first  place,  the  danger  of  communicating  hereditary  or 
acquired  disease,  when  the  blood  of  one  person  is  placed  in  con- 
tact with  a  raw  surface  of  another  must  be  evident  to  all. 


Secondly.  No  thought  seems  to  have  been  given  as  to  how 
the  tooth  attached  itself.  It  seems  to  have  been  put  in  in  a  hap- 
hazard sort  of  way,  with  an  indefinite  idea  that  it  would  grow 
into  the  gum.  Now,  it  is  due  to  the  pericementum  of  the 
tooth,  which  is  the  analogue  of  the  periosteum  of  the  bones, 
that  attachment  to  the  walls  of  the  socket  is  possible.  And  it  is 
readily  seen,  that  some  of  the  clot  into  which  the  tooth  is 
thrust,  must  remain  between  the  root  and  the  socket,  preventing 
that  intimate  contact  between  the  pericementum  and  the  alveolar 
wall  so  requisite  for  union,  to  say  nothing  of  the  septic  dangers 
attendant  upon  a  decomposing,  confined  clot.  But,  supposing 
this  difficulty  and  danger  to  be  overcome,  and  sufficient  union 
effected,  we  come  to 

Thirdly.  The  pulp  or  nerve,  as  it  is  called  by  the  laity,  is  the 
substance,  the  death  of  which,  jDroduces  that  frightful  torture 
attendant  on  the  formation  of  what  is  known  as  alveolar  abscess. 
The  pulp  then  in  these  transplanted  teeth, — being  devitalized  by 
the  solution  of  continuity  effected  in  extraction,  and  being  un- 
like the  pericementum  in  its  power  to  retain  vitaKty, — dies,  and 
in  its  death,  unless  the  tooth  is  secured  by  ligatures  or  other- 
wise, and  the  gases  evolved  are  not  sufficient,  consequently,  to 
expel  it,  all  the  painful  train  of  phenomena  attendant  on  the 
formation  of  alveolar  abscess  are  sure  to  follow. 

Fourthly.  If,  in  spite  of  all  these  deterring  causes,  the  tooth 
should  become  fixed  in  its  new  habitation,  the  decomposed  pulp 
is  partly  absorbed  by  the  tubuli  of  the  dentine  and  the  tooth 
becomes  blackened  and  unsightly. 

With  the  operation  performed  in  this  manner,  we  cannot  but 
agree  with  other  writers  on  the  subject,  that  transplantation 
of  teeth  is  accompanied  with  great  danger  and  is  bound  to  be  a 
failure. 

But  transplantation  can  be  made  a  success  and  void  of  all  danger 


and  unpleasant  consequences,  if  only  common  sense,  and  cleanli- 
ness, ordinary  skill  and  care  are  taken. 

It  is  to  prove  this  and  unprejudice  the  scientific  mind,  and, 
through  it,  the  public,  and  to  do  away  with  the  abomination  of 
false  teeth,  that  I  here  present  to  the  profession  the  results  of 
my  experiments  and  experience  in  this  direction. 

I  gained  courage  to  try  the  operation  by  reflecting  on  the  ex- 
periment of  John  Hunter,  who,  to  test  the  vitality  of  the  peri- 
cementum, planted  a  tooth  in  a  cock's  comb.  This  tooth  at- 
tached itself  firmly  to  the  crest,  and  a  few  mouths  afterwards 
the  cock  was  killed  and  a  microscopical  examination  showed  that 
a  living  union  had  taken  place,  the  blood  vessels  of  the  comb 
and  pericementum  having  established  free  communications. 

I  also  tried  the  experiment  upon  a  cock's  comb,  to  further  and 
personally  assure  myself  of  the  truth  of  this  statement,  and 
confirmed,  as  far  as  attachment  was  concerned,  the  exi^eriment 
of  the  great  surgeon.  But,  in  my  experiment,  I  took  the  pre- 
caution of  removing  the  pulp  and  filling  the  pulp  chamber  and 
root  canal  with  a  preparation  of  gutta  percha,  known  as  "Hill's 
stopping,"  much  used  by  dentists  for  temporary  fillings.  This 
was  in  order  to  avoid  any  trouble  from  a  decomposing  pulp. 
The  tooth  was  then  well  cleansed  with  warm  water  and  dipped 
in  a  disinfecting  solution.  The  success  of  this  experiment  sat- 
isfied me  that  the  pericementum  would  attach  itself  to  any  vas- 
cular body,  and  that,  if  properly  planted  in  a  fresh  socket,  it 
would  attach  itself  and  form  a  living  union  with  the  surround- 
ing tissues,  without  the  production  of  afterpains  or  other  evil 
consequences. 

My  first  experiment  January  24:th,  1881,  was  on  a  Mrs.  H.,  a 
lady  of  about  36,  who  had  nursed  a  badly  diseased  root  of  a  left 
superior  lateral  incisor  for  fifteen  years,  in  order  to  maintain 
the  contour  of  the  gum,  while  wearing  a  plate  with  an  artificial 


8 

crown  resting  on  it.  Whilst  waiting  for  a  lateral,  I  cured  the 
diseased  root,  but  kept  its  shattered  parts  together,  in  order  to 
presei*ve  the  socket  intact.  There  had  been  so  much  disease  in 
this  socket  that  the  gum  was  covered  with  cicatrices,  the  sequel- 
Ise  of  different  discharges.  At  last  I  procured  the  tooth  needed 
from  a  lady  of  about  forty,  and  prepared  it  in  the  manner 
already  described  for  the  cock's  comb.  Before  doing  so,  I 
extracted  the  root,  in  order  to  allow  the  patulous  vessels  to  close 
of  their  own  accord.  "When  the  tooth  was  ready,  I  carefully 
wiped  out  the  clots,  rinsed  the  socket  with  a  disinfecting  solu- 
tion and  put  in  the  tooth.  Finding  the  root  a  little  too  long, 
Ij  cut  off  the  excessive  portion  of  the  apex,  cleansed  the 
socket  again,  pressed  the  tooth  into  position  and  held  it  in 
place  by  delicate  silk  ligatures.  No  pain  ensued,  no  swelling, 
and  no  unpleasant  symptoms,  of  any  kind  whatever,  developed. 
Four  days  after,  the  ligatures  were  removed  and  I  was  gratified 
to  find  the  tooth  well  attached  and  resisting  gentle  traction 
made  with  the  fingers.  The  ligatures  were  again  replaced,  in 
order  to  hold  the  tooth  firmly  in  position  until  the  attachments 
had  acquired  sufficient  strength.  In  four  weeks  they  were 
removed.  The  tooth  has  now  been  in  its  new  home,  nearly  five 
years  and  is  as  firm  in  its  place,  and  light  in  color,  as  any  tooth 
in  the  delighted  lady's  mouth. 

I  have  now  had  between  thirty  and  forty  cases  of  transplant- 
ation into  sockets  already  formed,  and  have  to  report  but  two 
failures.  One  due  to  the  patient's  own  neglect,  in  leaving  for 
foreign  parts  too  soon  after  the  operation,  and  not  allowing 
me  to  place  the  ligatures  necessary  to  retain  the  tooth  in  a  fixed 
position,  until  sufficiently  strong  attachments  could  take  place, 
and  the  other,  to  my  own  inexperience.  In  the  latter  case,  there 
was  a  diseased  root  of  fourteen  years  standing.  The  attach- 
ments all  around  the  root  had  been  destroyed  and  the  tooth 


hung  but  by  a  pedicle  at  tlie  apex.  I  bad  not  bad  time  to  cure 
the  root,  and  so  I.  drilled  tbrougb  tbe  crown  of  the  new  tooth 
into  the  pulp  chamber,  forming  a  canal  through  to  the  end,  for 
drainage,  and  to  treat  the  diseased  socket.  Unfortunately,  I 
did  not  scrape  away  sufficiently  the  healed  walls  of  the  socket, 
and,  therefore,  attachment  did  not  take  place  along  the  sides  of 
the  root.  The  tooth,  not  tightening,  became  a  nuisance  to  the 
lady,  who  was  of  a  highly  nei-vous  temperament,  and  three 
months  after  its  insertion  it  was  removed. 

One  case,  where  I  had  but  little  hope  of  success,  turned  out  a 
decided  one.  At  the  time,  I  was  surprised,  but  since  I  have 
discovered  the  wonderful  gi'ip  a  little  pericementum  has,  I  am  no 
longer  surprised  at  anything  this  remarkable  membrane  will  do. 
As  there  was  a  little  sentiment,  besides  cold  science,  connected 
with  this  case,  I  take  a  special  pleasure  in  narrating  it.  Two 
young  girls  of  sixteen,  merry,  laughing,  loving  little  friends, 
came  to  me,  one  had  an  upper  bicuspid  that  was  overcrowding 
her  otherwise  lovely  mouth;  the  other  a  badly  formed,  worse 
decayed  and  painful  lower  one  in  hers,  and  they  asked  me  if  I 
would  not  please  take  the  one  out  and  insert  the  other  in  its 
place.  But  as  the  root  of  the  upper  was  considerably  wider  than 
the  lower,  and  would  necessitate,  to  fit  the  tooth  properly,  the  re- 
duction of  the  diameter  of  the  root,  and  thereby  involve  the  de- 
struction of  considerable  pericementum,  I  did  not  consider  it 
practicable.  Nevertheless,  as  they  seemed  to  have  set  their 
hearts  upon  it,  evidently  believing  that  this  transfer  of  tooth, 
would,  in  some  subtle  manner,  unite  them  more  closely,  and  the 
one  declaring  her.  willingness  to  suffer  any  pain,  even  with  the 
slight  chance  of  success  promised,  to  have  her  wish  consummated, 
I  yielded.  In  this  operation  I  had  to  grind  away  the  labio-lin- 
gual  aspects  of  the  root,  thus  denuding  the  whole  of  these  sur- 
faces of  pericementum,  and  leaving  but  two  strips  of  this  mem- 


10 

brane,  one  anteriorly,  and  the  other  posteriorly,  with  which  to 
form  attachments.  Nevertheless,  it  did  so,  and  it  is  now  one  of 
the  best  and  firmest  teeth  the  young  lady  has  in  her  head.  This 
operation  was  ijerformed  Feb.  21st,  1881,  but  a  month  later  than 
the  one  previously  rei^orted. 

The  great  and  only  difficulty  I  had  to  contend  with,  was  the 
procurement  of  teeth  at  the  time  they  were  needed.  At  last  a 
way  suggested  itself.  I  applied  to  my  dental  friends  for  what- 
ever good  teeth  or  roots  the  exigencies  of  cases  required  them  to 
extract.  The  experiment  of  Hunter  and  my  own  experience 
had  taught  me  that  teeth  could  be  kept  alive,  indefinitely,  in 
cocks'  combs.  But  could  they  be  transferred  to  the  human 
mouth  again  and  made  to  grow  there  ?  I  concluded  they  could, 
and  my  first  experiment  verified  my  conclusion. 

On  November  28th,  1882,  a  bicuspid  that  had  been  in  a  cock's 
comb  for  ten  days,  was  transferred  to  the  mouth  of  a  gentleman, 
where  it  fastened  itself,  as  if  there  had  been  no  gallinaceous 
period  in  its  existence. 

Where  I  have  not  been  able  to  procure  a  suitable  tooth,  I  have 
taken  a  root,  and  mounted  an  artificial  crown  on  it.  Sometimes 
I  use  the  natural  crown  of  a  tooth  that  has  been  irretrievably 
loosened  by  incrustation  of  tartar  on  its  root.  In  this  case  I 
simply  saw  off  the  bad  root  and  attach  a  good  one  to  the  crown 
by  means  of  one  or  more  gold  screws  and  cement.  In  these  cases 
the  patient  simply  changes  roots.  I  have  also  discovered  that 
the  pericementum  can  be  kept  alive  for,  certainly,  two  days,  in 
warm  water,  temperature  100^  to  110^  Fahrenheit.  I  have  in  two 
cases  transj)lanted  teeth  successfully  that  had  been  so  kept  for 
fifty  hours. 

My  former  practice  when  I  found  a  root  was  too  long  or  too 
wide  for  9,  socket,  was  to  cut  off  from  the  apical  extremity,  or 
shave  off  from  the  surface  of  the  root,  the  necessary  quantity  to 


11 

insure  a  fit:  but  so  often  the  best  portion  of  the  pericementum 
was  in  that  way  removed,  that  I  tried  deepening  or  widening 
the  cavity  as  the  case  required,  often  cutting  freely  into  the  bone 
in  order  to  save  all  possible  of  this  valuable  tissue.  I  found  that 
adhesion  took  place  in  this'  portion  as  perfectly  as  in  the  un- 
broached.  The  consideration  of  this,  led  me  to  the  grand  con- 
clusion, that  artificial  sockets  could  be  drilled  into  the  bone  ilaelf 
and  teeth  planted  therein  as  successfully  as  into  the  natural  cavities. 
My  first  operation  of  this  nature  was  reported  to  the  Califor- 
nia State  Dental  Association  in  August  last,  and  its  success  was 
witnessed  by  them  seven  weeks  after  its  j)erformance.  But  as 
the  transactions  of  this  society  for  this  year,  will  not  be  pub- 
lished for  some  time,  I  will  incorporate  that  report  in  this  article. 


On  the  17th  of  June  last,  Miss  Ward,  a  young  lady  of  24, 
presented  herself.  She  had  lost  the  left  superior  lateral  incisor, 
root  and  all,  four  years  previously,  and  had  been  wearing,  as  a 
substitute,  an  artificial  tooth  on  a  rubber  plate.  The  collapse 
of  the  gum,  consequent  on  the  absorption  of  the  alveolus,  was 
so  great,  and  the  exposure  of  gum  so  much,  in  conversation, 
and  especially  in  smiling,  that  the  falsity  of  the  denture  was  im- 
mediately recognized,  and  was  an  object  of  great  distress  to  her. 
As  it  was  impossible,  for  the  reasons  just  given,  to  produce  an 
artificial  substitute  that  would  look  natural,  I  determined  ujjon 
the  following  operation, — one  that  I  had  for  a  long  time  contem- 
plated, and  which,  though  satisfied  in  my  mind,  in  consequence 
of  certain  obseiwations  and  experiments,  would  be  successful, 
seemed  so  opposed  to  scientific  thought  and  the  established  rules 
of  surgery,  that  I  had  not  before  screwed  up  my  courage  suffi- 
ciently to  attempt  it.  I  took  a  corresponding  lateral  from  a 
young  man,  which,  from  its  awkward  position,  was  disfiguring 


12 

his  mouth,  and  prepared  it  as  I  do  all  teeth  I  use  in  transplanta- 
tion, viz. :  removed  the  pulp,  filled  the  pulp  chamber  and  root 
canal  with  Hill's  stojjping,  and  finished  the  apex  with  gold. 
The  tooth  was  then  placed  in  water  of  the  temperature  100°  to 
110°  Fahrenheit,  to  cleanse  it  of  all  blood  and  impurities,  and 
allowed  to  remain  for  about  one  hour.  It  was  then  placed  in  a 
bath  of  bi-chloride  of  mercury,  2  parts  to  1,000  water,  for  about 
fifteen  minutes,  to  disinfect  it.  The  tooth  being  now  ready,  I 
turned  my  attention  to  the  patient.  I  cut  a  hole  in  the  gum  a 
little  less  than  the  diameter  of  the  root  to  be  inserted.  I  then 
took  an  ordinary  flat,  angular-edged  drill,  and  drilled  into  the 
bone  in  the  line  of  direction  the  tooth  was  to  occupy.  When 
fully  deep  enough,  I  widened  the  cavity  and  formed  the  socket 
with  a  cone-shaped  burr.  When  I  found  by  trial  that  the  cavity 
would  receive  the  tooth  perfectly,  I  carefully  washed  and  sponged 
it  out,  in  order  to  remove  eveiy  particle  of  detached  bone,  first 
with  warm  water,  then  with  cold,  and  lastly  with  the  bi-chloride 
solution  already  referred  to,  and  when  the  bleeding  had  ceased, 
I  introduced  the  tooth,  and  kept  it  in  position  by  delicate  silk 
ligatures  attached  to  the  central  incisor  on  the  right  and  to  the 
canine  on  the  left.  There  resulted  a  little  swelling  over  the  root, 
which  remained  a  few  days  and  then  gradually  disappeared. 

An  accident  to  the  gum  occurred  during  the  development  of 
its  socket.  Just  as  the  drill  touched  the  surface  of  the  bone 
the  young  lady  jerked  her  head  back,  which  caused  the  instru- 
ment to  slip  forward  and  through  the  gum,  making  a  triangular 
shajDed  gash  of  fully  an  eighth  of  an  inch  in  length.  Before 
the  tooth  was  inserted  the  edge  of  this  cut  was  brought  care- 
fully together  and  retained  in  contact  by  delicate  silk  sutures. 
On  the  fourth  day  the  sutures  were  removed  and  no  mark  was 
apparent  to  tell  of  the  lesion  that  had  existed.  In  twelve  days 
I  removed  the  ligatures  from  the  tooth  and  found  it  well  at- 


13 

tached.  I  then  removed  the  threads  to  fix  the  tooth  while  the 
callus  foiiued  I'ound  the  root.  About  three  weeks  afterwards, 
the  gum  being  free  from  every  sign  of  irritation  and  the  tooth 
comparatively  firm,  and  desiring  to  improve  the  position  of  the 
right  superior  central  and  lateral,  I  had  to  pass  the  ligatures  around 
the  new  tooth.  This,  unfortunately,  set  up  a  slight  inflamma- 
tory action,  and  an  epulis  formed  a  few  days  after,  and  a  little 
discharge  of  matter  took  place.  I  thereupon  removed  the  liga- 
tures and  treated  with  injections  of  iodine.  When  last  seen 
the  epulis  had  nearly  disappeared,  the  surrounding  gum  had 
resumed  its  normal  look,  the  tooth  become  firm  in  its  position 
and  performing  its  functions  in  common  with  its  fellow  teeth  as 
though  it  had  never  been  a  stranger  in  the  mouth. 

This  case  was  examined  by  several  physicians,  and  by  the 
members  of  the  California  State  Dental  Association,  who,  with 
the  exception  of  two,  pronounced  the  operation  a  great  success. 
These  two  gentlemen  were  not  thoroughly  satisfied  with  its 
stability  because,  only,  of  the  epulis  that  had  formed. 

CASE   TWO. 

On  the  15th  of  August  and  the  5th  of  September,  similar 
operations  were  performed  on  Mrs.  C. ,  set.  35.  In  Mrs.  C.  's  case, 
however,  the  teeth  (superior  bicuspids)  had  been  absent  for 
twenty  years,  and  during  this  time  she  had  worn  an  artificial 
plate. 

On  the  first  date  mentioned,  a  socket  was  drilled  out  immed- 
iately on  the  right  of  the  right  superior  canine,  and  a  bicuspid 
inserted.  It  was  held  in  position  by  a  silk  thread  attached  to 
the  canine  and  lateral  in  front,  and  a  molar  a  little  distance  in 
the  rear,  the  thread  simply  passing  over  the  crown  between  the 
cusps  like  a  tight-rope. 

On  the  5th  of  September,  Mrs.  C. ,  being  satisfied  of  the  success 


14 

of  the  operation,  bad  two  bicuspids  inserted  in  the  left  side  in  a 
similar  manner.  In  this  case,  however,  there  was  no  molar  to 
attach  a  thread  to  and  so  a  little  loose,  diseased  root  of  a  second 
molar  had  to  be  brought  in  requisition.  Into  this  root  a  fine 
gold  wire  was  inserted  to  which  the  distal  end  of  the  string  was 
attached,  the  string  brought  taut  over  the  crowns  and  between 
the  cusps  and  fastened  to  the  canine  and  lateral  in  front.  After 
the  insertion  of  these  teeth  the  face  swelled  slightly,  but  there 
was  no  tendency  to  expel  the  teeth,  nor  was  there  any  pain  con- 
nected with  them.  The  face  was  washed  with  the  ordinary  solu- 
tion of  muriate  of  ammonia  in  water  and  alcohol,  and  the  gum 
painted  with  iodine.  In  four  days  the  swelling  subsided.  The 
gums  have  now  been  for  over  two  months  without  the  slightest 
mark  of  irritation.  The  teeth  have  become  quite  firm,  and  the 
lady  is  now  using  them  in  mastication,  There  are  three  more 
teeth  yet  to  be  inserted, — one  right  bicuspid  and  two  left 
superior  molars, — which  will  be  done  as  soon  as  the  proper  teeth 
are  procured. 

Among  the  many  medical  and  dental  gentlemen  who  have 
critically  examined  this  case,  and  expressed  themselves  fully 
satisfied  with  the  success  and  utility  of  this  operation,  are: 

Prof.   E.  Beverly  Cole,  A.  M.,  M.  D.,  M.  E.  C.  S.,  Medical 

Department,  University  of  California. 
Prof.  F.  H.  Terrill,  M.  D.,  Medical  Department,  University  of 

California. 
Wm.   S.  Whitwell,  A.M.,  M.  D.,  Editor  Pacific  Medical  and 

Surgical  Journal. 
"Wm.  T.  Grarwood,  M.  D.,  former  Eesident  Physician  City  and 

County  Hospital. 
A.  F.  Sawyer,  A.M.,  M.  D. 
C.    M.    Eichter,  M.   D.,  late  Chief  Surgeon  of  the    G-erman 

Hospital, 


15 

J.  A.  W.  Lundborg,  President  California  State  Dental  Asso- 
ciation. 

S.  E.  Knowles,  M.  D.,  D.  D.  S.,  President  San  Francisco 
Dental  Association. 

"NVm.  A.  Knowles,  M.  D.,  D.  D.  S.,  Vice-President  California 
State  Dental  Association. 

Alex.  "Warner,  D.  D.  S.,  late  President  California  State  Den- 
tal Association. 

So  perfectly  natural  is  the  appearance  of  these  teeth  in  the 
mouth,  so  firm  and  so  normal  the  surrounding  gum,  that  the 
great  majority  of  these,  as  well  as  of  other  gentlemen  who  have 
seen  the  case,  were  unable,  when  put  to  the  test,  to  distinguish 
the  transplanted  teeth  from  those  that  were  "  native  and  to  the 
manor  born."  Many  mistook  some  of  the  old  teeth  for  the  new, 
and  the  three  or  four  who  did  point  out  the  right  teeth  acknowl- 
edged that  they  merely  guessed  them,  in  consequence  of  their 
being  handsomer  and  better  than  the  other  teeth. 

Mrs.  C.  herself  says:  ''"When  I  think  that  for  twenty  long 
years  I  have  had  to  wear  a  nasty,  old  i^late,  and  now  I  have  in- 
stead natural  teeth  growing  in  my  mouth,  I  feel  so  hapjDy  that  I 
cannot  express  myself." 

Practical  experiments  have  convinced  me  that  the  views 
expressed,  of  the  formation  of  the  socket,  and  method  of  attach- 
ment of  the  teeth,  in  the  books  on  this  subject,  are  erroneous, 
and  in  a  subsequent  paper,  I  hope  to  discuss  the  method  of 
attachment  of  the  teeth  in  artificial,  as  well  as  natural  sockets, 
and  to  prove  theoretically,  as  well  as  I  have  practically,  that 
they  may  be  transplanted  and  made  to  grow  in  the  former,  as 
well  as  the  latter,  and  be  as  perfect  in  appearance  and  utility  as 
if  they  were  the  development  of  the  very  jaw  itself,  and  that  this 
can  be  a  rule  and  not  an  exception. 


16 


ADDENDA. 


On  the  3d  of  December,  1885,  a  right  superior  central  that 
had  been  extracted  from  a  young  lady  by  a  professional  friend, 
was  inserted  into  an  artificial  socket  formed  in  the  mouth  of  Mr. 
James  J.  Molony,  a  gentleman  of  34,  who  had  lost  a  correspond- 
ing tooth  13  years  previously.  This  tooth  had  been  fifty  hours 
out  of  its  original  owner's  mouth  before  transplantation.  So 
perfect  is  the  appearance  of  this  tooth  and  the  surrounding  gum, 
and  so  firmly  has  it  become  fixed,  that  prominent  physicians  and 
dentists,  to  whom  Mr.  Molony,  in  his  enthusiasm,  showed  the 
tooth,  disputed  his  word,  and  one  of  our  oldest  practitioners, 
Dr.  H.  H.  Thrall,  had  to  come  to  me  in  person,  to  satisfy  himself 
as  to  the  truth  of  this  gentleman's  statement. 

On  the  8th  of  December  just  past,  a  right  lower  wisdom  tooth 
that  had  been  extracted,  to  relieve  an  overcrowded  maxilla,  was 
planted  in  the  left  superior  jaw  of  a  Mrs.  E.,  aged  45.  This  lady 
had  lost  all  the  teeth  on  one  side  of  that  jaw,  with  the  exception 
of  the  second  bicuspid,  through  phagedenic  pericementitis,  and 
had  but  one  molar  left  in  the  lower.  This  tooth  was  planted 
directly  over  that  molar,  and  its  articulation  with  it  is  perfect. 
It  was  held  in  position  for  three  weeks,  by  a  silver  band  attached 
to  a  clasp  fitted  to  the  bicuspid  already  mentioned  that  extend- 
ed to  and  nearly  surrounded  the  transplanted  molar.  The 
band  was  removed  and  the  tooth  found  so  well  attached,  that  no 
farther  support  was  deemed  necessary. 

This  tooth  was  inserted,  with  a  good  many  misgivings  as  to  its 
success;  for,  in  the  first  place,  the  negligence  of  my  assistant  al- 
lowed the  temperature  of  the  water,  in  which  the  tooth  was  kept 
immersed  over  night,  to  run  up  to  150^  F.,  and  it  must  have  suf- 
fered that  heat,  for  at  least  ten  or  fifteen  minutes  before  discov- 
ery.    In  the  second  place,  the  absorption  of  alveolus  had  become 


17 

so  great,  that  wlien  the  tooth  was  placed  in  situ,  only  two-thirds 
of  the  roots  were  imbedded  in  the  gum  and  bone.  Neverthe- 
less, the  tooth  is  becoming  firmer  every  day,  and  promises  in  a 
month  or  two,  to  do  as  good  service  as  ever  its  predecessor  did. 
The  part  into  which  this  tooth  was  inserted  had  been  edentulous 
for  two  years. 

On  December  15th,  the  fourth  bicuspid  was  planted  in  Mrs. 
C.'s  mouth,  which  completes  all  the  operations  of  this,  kind  re- 
quired on  the  right  upper  jaw.  Next  month  we  propose,  D.  V., 
to  plant  a  molar  on  the  left  side  and  immediately  in  the  rear  of 
the  bicuspids,  inserted  on  the  5th  of  last  September. 

This,  it  will  be  remembered,  is  the  fourth  tooth  thathas  been 
planted  in  this  lady's  mouth.  The  retaining  ligature  was  re- 
moved on  the  second  of  this  month  (January),  and  the  tooth 
found  unusually  firm.  It  has  been,  since  that  time,  without  any 
other  support  than  the  living  one  derived  from  its  environment. 

I  have  now  transplanted  into  artificial  sockets,  seven  teeth; 
four  into  one  mouth  and  one  each  into  three  others.  They  have 
been  one  central  incisor,  one  lateral  incisor,  four  bicuspids  and 
one  molar.  Sufficient  variety  to  show,  that  a  whole  sett  may  be 
thus  planted  into  an  edentulous  jaw,  even  after  the  teeth  have 
been  absent  for  twenty  or  more  years.  I  have  as  yet  had  no 
failures,  and  with  proper  care  and  under  proper  conditions,  I 
have  no  fear  of  any. 

Science  has  been  startled  at  the  success  of  this  operation, 
from  what  I  believe  to  be  a  misconception  of  the  relation  of  the 
tooth,  to  the  alveolar  socket,  through  the  pericementum  or  p6ri- 
dental  membrane.  Some  believing  this  membrane  to  be  a  sin- 
gle tissue,  having  two  creative  sides,  one  producing  the  cementum 
and  the  other,  the  alveolar  socket;  others,  that  it  is  a  double  or 
reflex  membrane,  one  being  a  true  periosteum  and  producing 
the  bony  environment  surrounding  the  tooth,  and  the  other,  a 


18 

modified  tissue  generating  cementum,  a  substance  which  being 
analogous  to  bone  is  yet  not  true  bone. 

I  am  convinced  that  the  alveolar  socket  has  no  periosteum, 
and  that  only  one  side  of  this  single  or  double  membi'ane,  has  a 
callus  generative  energy,  and  that  is,  its  dental  aspect ;  the 
other,  has  simply  the  power  of  forming  attachment. 

True  periosteum  will  revive  its  function  of  producilig  bone, 
after  its  first  osseous  creation  has  been  removed,  and  if  the  outer 
layer  or  side  of  the  peridental  membrane  was  such,  it  would 
also  produce  callus,  upon  the  loss  of  its  osseous  structure.  But 
in  treating  irregularities  of  the  teeth,  where  a  malposed  tooth 
has  to  be  moved,  sometimes  a  quarter  of  an  inch,  we  find  the 
deposition  taking  place,  from  the  alveolar  surface  only  and  con- 
tinuing from  there,  until  the  tooth  is  reached.  Also  in  the 
experiment  on  the  cock's  comb,  it  simply  forms  attachments  with 
the  surrounding  vascular  substance,  without  producing  the  pe- 
trous crust,  which  it  would  do,  had  it  the  function  of  periosteum. 
Besides,  if  the  development  of  a  tooth  is  followed,  it  will  be 
seen,  that  no  periosteum  is  employed,  in  the  formation  of  the 
socket.  It  is  the  pressure  of  the  crown,  due  to  the  force  of 
growth  in  the  developing  tooth,  that  produces  the  absorption  of 
bone,  necessary  for  its  eruption.  While  the  crown  is  in  the 
alveolar  process,  there  is  no  attachment  to  it,  and  there 
is  certainly,  no  periosteum  lining  the  alveolar  wall.  "When 
the  crown  has  passed  through  into  the  mouth  and  the  root 
or  roots  of  the  tooth  have  taken  its  place,  in  the  space  formed 
in  the  alveolus,  its  wall  is  still  as  minus  a  periosteum,  as  when 
the  unsympathetic  crown,  forced  its  way  through.  Now,  the 
crown  of  the  tooth,  is  considerably  larger  than  the  body  and 
roots,  and  makes  a  larger  space  in  its  progress,  than  is  required 
by  its  continuation.  Therefore,  when  the  crown  has  escaped 
from  its  osseous  imprisonment,  there  is  a  space  left  between  the 


11) 

tooth  and  the  alveolar  wall.  This  enables  the  tooth,  to  assume  its 
recjuired  elevation  in  the  mouth,  before  the  deposition  of  bone, 
fills  up  the  space  and  firm  attachments  take  place. 

I  think  I  have  shown,  that  the  investing  membrane  of  the  tooth 
produces  callus  only  on  its  dental  aspect;  that  the  socket,  being 
formed  by  the  crown,  no  periosteum  is  present  or  engaged 
in  its  formation  ;  therefore,  this  filling  up  of  the  space  with 
osseous  matter,  and  attachment  to  the  pericementum  must  come, 
and  is  only  possible,  from  the  eadosleam.  This  delicate  mem- 
brane, lining  the  cells  and  interstices  of  the  bony  structure,  is 
but  a  continuation  of  the  periosteum,  surrounding  the  maxillary 
bone  and  alveolar  process,  and  has,  as  is  well  known,  all  the 
powers  of  its  mother  tissue.  In  moving  a  tooth  from  a  wrong 
position  into  a  right  one,  the  space  left,  is  filled  up  and  attach- 
ment renewed  by  this  endosteum.  When  a  tooth  is  e.Ktracted, 
it  is  due  to  the  endosteum  that  the  space  is  filled.  When  a  lesion 
occurs  in  the  jaw  or  other  bones,  at  points  remote  from  peri- 
osteum, it  is  to  this  very  membrane  that  reparation  is  due. 
Therefore,  when  a  socket  is  artificially  formed,  and  a  tooth  is 
planted  therein,  it  must  be  evident,  that  it  is  the  endosteum  of 
the  osseous  surrounding,  that  performs  the  task  of  union,  and 
that  it  will  do  so,  as  naturally  with  a  strange  tooth,  as  with  the 
organ  developed  in  its  own  structure;  for,  to  the  endosteum,  it 
makes  no  difference,  if  the  lesion  in  its  structure  is  caused  by  a 
developing  tooth  or  by  an  instrument.  It  is,  in  either  case, 
a  lesion,  and  only  the  variation  in  a  subjective,  from  an  object- 
ive cause. 

I  am  about  to  commence  a  series  of  operations  on  rabbits  and 
other  animals,  to  test  the  assertions  I  have  made,  regarding  the 
reparation  of  bone  and  attachment  of  a  tooth  thereto,  b}'  drilling 
into  some  portion  of  their  osseous  structure,  and  planting  roots 
into  the  cavities  thus  formed.     At  different  times,  the  animals 


20 

will  be  killed  and  microscopical  examinations  made.  In  this 
way,  I  hope  to  place  beyond  doubt,  the  method  of  attachment 
of  a  tooth  to  a  bony  surface.  I  shall  publish  the  result  of  these 
experiments,  trusting^  that  it  will  lead  the  professional  mind, 
everj'where,  to  a  kind  consideration  and  endorsement  of  this 
operation,  and  thus  assist,  in  doing  away  with  the  necessity  for 
false  teeth,  and  so,  add  immeasurably,  to  the  comfort,  beauty  and 
health,  of  the  human  mouth. 


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COLUMBIA  UNIVERSITY  LIBRARIES  (hsi.stx) 

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Transplantation  ol  teeth  into  artificial 


2002398532 


Younger 


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Y8 

1886 


JAfl4 


Transplantation  of  teeth  into 
artificial  sockets. 


«. 


^UaiNDEHY 


-^m^^ 


